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Implementation of a Cataract Pre-operative Risk Stratification System and its Predictive Value on Intra-Operative Complications and Post-Operative Results

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Posterboard#: B0341

Abstract Number: 2043 - B0341

AuthorBlock: Jason Fan1, Dan Gong1, Joaquin De Rojas1, Bryan Winn1, George Cioffi1, Royce Chen1
1Ophthalmology, Columbia University, New York, New York, United States;

DisclosureBlock: Jason Fan, None; Dan Gong, None; Joaquin De Rojas, None; Bryan Winn, None; George Cioffi, None; Royce Chen, None;

Purpose
This study determined how a novel cataract surgery grading system might predict intra-operative complications and post-operative results at a U.S. training program.

Methods
We included 320 resident cases from January to September 2018 performed at a single institution. Risk scores, pre-operative best-corrected visual acuity (BCVA), intra-operative complications, post-operative day 1 (POD1) and month 1 (POM1) BCVA, and POM1 exam findings were tabulated. OLS and logistic regression analysis were used for continuous and binary variables, respectively.

Results
Mean pre-operative BCVA was 0.40 LogMAR, POD1 BCVA was 0.29, and POM1 BCVA was 0.16. Risk scores ranged from 0 to 8 (mean = 1.28). 4.4% of cases had posterior capsule ruptures, and 3.8% had vitreous loss. Risk scores did not have a significant association with intraocular lens location or the occurrence of intra-operative posterior capsule rupture, vitreous loss, hyphema, or iris prolapse. Risk scores were predictive of POD1 BCVA (β=0.043, p<0.001), POM1 BCVA (β =0.029, p=0.007), and the presence of POM1 Descemet membrane folds (OR=1.27, p=0.032) and corneal edema (OR=1.34, p=0.006). Worse pre-operative visual acuity increased the likelihood of IOL placement in the sulcus (β=4.52, p=0.019) and Descemet membrane folds (β=4.25, p=.004). The presence of a posterior subcapsular cataract (PSC) increased the likelihood of worse POD1 (β=0.039, p=0.008) and POM1 (β=0.033, p=0.002) BCVA, sulcus IOL (OR 1.90, p=.001), and vitreous loss (OR 1.74, p=0.004). Advanced age (>88 years) predicted nuclear sclerosing (OR 1.09, p=0.001) and cortical (OR 1.03, p=0.036) cataracts, but not PSCs, as well as high intraoperative phacoemulsification energy requirement (β=1.18, p=0.025).

Conclusions
In its current implementation, our institution’s pre-operative cataract surgical risk score was highly correlated with post-operative visual acuity and the presence of POM1 Descemet membrane folds and corneal edema. Furthermore, we have identified particular risk factors (worse pre-operative visual acuity, PSC) that should be given special attention by surgical trainees due to their association with poorer outcomes.

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